- 9,736
- 1,174
- 113
Did you ever find out what this kid's deal was or are we just taking shots in the dark?
.
.
Maybe Really Altered?
- Thread starter Bigcha40
- Start date
Gave the narcan for altered mental status with unknown cause after ruling out hypoglycemia, like someone said earlier, hes in college...
Since the recent outbreak of this bath salt phenomenon i started to lean towards this after we treated for everything we could. I had done some research on symptoms of bath salts and it fit the profile.
Turns out, about 2 hours after we got him to the hospital, he coded on them. Dont know all the details after that but they got him back. His tox screen came back postitive for opiates and bath salts, they ruled the cause to complications from the effects of bath salts.
The last i heard about him is he was still alive.
Since the recent outbreak of this bath salt phenomenon i started to lean towards this after we treated for everything we could. I had done some research on symptoms of bath salts and it fit the profile.
Turns out, about 2 hours after we got him to the hospital, he coded on them. Dont know all the details after that but they got him back. His tox screen came back postitive for opiates and bath salts, they ruled the cause to complications from the effects of bath salts.
The last i heard about him is he was still alive.
- 5,018
- 1,356
- 113
You gave narcan because you suspected he may have taken bath salts? :unsure:
As someone said earlier; from the information you gave, I see no reason to give narcan. Even if I did suspect he took an opiate, the rest of his presentation would lead me to think it would be laced with an upper, in which I would really not want to give narcan... If you didn't suspect an opiate, and just suspected the bath salts, them still no reason for narcan. Correct me if I'm wrong, but narcan is only effective on opiate overdoses.
As someone said earlier; from the information you gave, I see no reason to give narcan. Even if I did suspect he took an opiate, the rest of his presentation would lead me to think it would be laced with an upper, in which I would really not want to give narcan... If you didn't suspect an opiate, and just suspected the bath salts, them still no reason for narcan. Correct me if I'm wrong, but narcan is only effective on opiate overdoses.
Last edited by a moderator:
Gave him narcan because hes laying on my stretcher unresponsive... Whats an adverse effect of giving narcan? He loses his "high" if he has one? If that was what was wrong then hey you firgured it out, if not well then you possibly ruled out a cause.
Its not like a gave a 3rd degree block patient atropine and wonder why they died...
Not only because i thought he took bath salts. G
- 5,018
- 1,356
- 113
Have you had much experience with overdoses? Specifically of the recreational variety? Ever dealt with a patient speed balling? Not a personal attack, just out of curiosity.
Your patient is not at all presenting with a typical opiate overdose. He is presenting with a possible stimulant overdose: tachycardic, diaphoretic, combative, pupils regular (as opposed to pinpoint). The fact that he's semi-responsive Could indicate that he's on some sort of downer, such as an opiate or a benzo. But his respirations are good. His sats are good. Overall, he's pretty good right now. My vote: let him be, let him enjoy his high, and monitor him while you drive nice and chill to the hospital
So as far as side-effects of narcan. Directy? none really, besides maybe vomiting if you want to push it to fast. However, have you ever reversed an OD of somebody who was on an opiate and a stimulant? Your patient was already somewhat combative for you. That opiate may have been the only thing keeping him somewhat chill for you. Do you really want to be around when you push narcan and are now fighting with I opposed stimulant? As someone who's been there, I sure as hell wouldn't! Along similar lines, now would you not only be potentially fighting with the incredible coked-out Hulk, but now you have to worry about potential excited delirium if he really gets up and going. He's already pretty tachy and diaphoretic with the opiate helping keep him down. Those are some side effects I would personally like to avoid
Your patient is not at all presenting with a typical opiate overdose. He is presenting with a possible stimulant overdose: tachycardic, diaphoretic, combative, pupils regular (as opposed to pinpoint). The fact that he's semi-responsive Could indicate that he's on some sort of downer, such as an opiate or a benzo. But his respirations are good. His sats are good. Overall, he's pretty good right now. My vote: let him be, let him enjoy his high, and monitor him while you drive nice and chill to the hospital
So as far as side-effects of narcan. Directy? none really, besides maybe vomiting if you want to push it to fast. However, have you ever reversed an OD of somebody who was on an opiate and a stimulant? Your patient was already somewhat combative for you. That opiate may have been the only thing keeping him somewhat chill for you. Do you really want to be around when you push narcan and are now fighting with I opposed stimulant? As someone who's been there, I sure as hell wouldn't! Along similar lines, now would you not only be potentially fighting with the incredible coked-out Hulk, but now you have to worry about potential excited delirium if he really gets up and going. He's already pretty tachy and diaphoretic with the opiate helping keep him down. Those are some side effects I would personally like to avoid
Well played sir! lol
I agree, probably shouldnt have administered the narcan. just me personally i feel this sort of need to figure out what it is/was that made him like he is.
As for the dealing with the high coked-out patients, yea ive had a few... Specifically the one patient weve run on a few times who likes to: smoke meth, weed, take shrooms, and wash it all down with jack daniels...
Yea he always thinks there is a snake up his a$$ and wants us to pull it out. Hes kicked all of out a$$es before. Haldol, Versed, and Ativan wouldnt even touch that guy...
That's not exactly a good reason for anything...
Acute withdrawal, seizures, pulmonary edema, unopposed sympathetic stimulation, aspiration from vomiting...
Except Narcan can also reverse Klonopin on occasion, and you haven't really ruled it out till you get a tox back, and you should probably be able to get clues about what's going on by physical assessment before blindly pushing a drug.
Except atropine for 3rd degree is actually be more appropriate....
A&P, pathophys and pharm are our "stock in trade" so to speak. You should consider all three before you perform any treatment. Going around blindly pushing meds because "he's laying unresponsive on my stretcher" is weak sauce.
VFlutter
Flight Nurse
- 3,728
- 1,264
- 113
Really? I haven't heard that. Just Klonopin or other Benzos? Or Gabapentin
Can't find the reference at the moment, let me get home and I'll see if I can dig it up.
It's nice to figure out what's going on, but not required. Getting the pt (and yourself) to the hospital alive and safe is
required.
Figuring out what substances are in his body is what the Hospital Tox screen is for.
Melclin
Forum Deputy Chief
- 1,796
- 4
- 0
My 2 cents, such as its is:
I wouldn't give this guy narcan. Its reasonably safe but not giving it is safer, assuming its not indicated and it doesn't sound like it was.
It doesn't sound at all like an uncomplicated opiate OD, so I'm still not sure why you gave the narcan. Were you under the impression that it works on bath salt related OD as well?
If you then hypothetically change this situation such that he does present more like an opiate OD then I still don't think this guy requires narcan. You're trying return the pt to a state in which they protect their own airway and are breathing with an adequate minute volume. Sounds like he had both of those things. So what are you achieving by giving narcan? Once he became unresponsive, was he protecting his airway as far as you could tell?
Not having a crack at you, but you present a case for consideration so we're considering and providing questions and feedback consistent with the purpose of this part of the forum.
This.
I wouldn't give this guy narcan. Its reasonably safe but not giving it is safer, assuming its not indicated and it doesn't sound like it was.
It doesn't sound at all like an uncomplicated opiate OD, so I'm still not sure why you gave the narcan. Were you under the impression that it works on bath salt related OD as well?
If you then hypothetically change this situation such that he does present more like an opiate OD then I still don't think this guy requires narcan. You're trying return the pt to a state in which they protect their own airway and are breathing with an adequate minute volume. Sounds like he had both of those things. So what are you achieving by giving narcan? Once he became unresponsive, was he protecting his airway as far as you could tell?
Not having a crack at you, but you present a case for consideration so we're considering and providing questions and feedback consistent with the purpose of this part of the forum.
This.
NomadicMedic
I know a guy who knows a guy.
- 12,119
- 6,859
- 113
I'm interested in seeing this reference, too. I just did some digging and couldn't find a thing.
Yeah, I can't seem to find it either, it appears I was talking out of my gluteus. I'm trying to remember where I heard it...
mycrofft
Still crazy but elsewhere
- 11,322
- 48
- 48
Trust your assessments and know your algorithms, if not physiology and PE
Pupillary diameter?
A. If student was drinking or doing drugs, very likely his roomies will not cop to it.
B. Hypnosis may change behavior and mood, but not to the point of raising pulse PLUS normotensive (partial response to endogenous adrenaline:unsure:? Or is the body compensating for some other cause for loss of BP? Or is the pt just transiently angry that he was stabbed in the arm?).
C. Does "semi-combative" mean resistive (which can be a basic irritant response) or want to fight? A difference clinically as to level of consciousness.
My quarter in the pool says most likely alcohol toxicity or psychoactive drugs, maybe baseline mental illness to boot. Calm everyone down, but get to medical facility as he will need pre-arrest screening including tox screen, blood alcohol.
PS: Another quarter: temp, PE and CBC to r/o sepsis.
Pupillary diameter?
A. If student was drinking or doing drugs, very likely his roomies will not cop to it.
B. Hypnosis may change behavior and mood, but not to the point of raising pulse PLUS normotensive (partial response to endogenous adrenaline:unsure:? Or is the body compensating for some other cause for loss of BP? Or is the pt just transiently angry that he was stabbed in the arm?).
C. Does "semi-combative" mean resistive (which can be a basic irritant response) or want to fight? A difference clinically as to level of consciousness.
My quarter in the pool says most likely alcohol toxicity or psychoactive drugs, maybe baseline mental illness to boot. Calm everyone down, but get to medical facility as he will need pre-arrest screening including tox screen, blood alcohol.
PS: Another quarter: temp, PE and CBC to r/o sepsis.
Pupillary diameter?
A. If student was drinking or doing drugs, very likely his roomies will not cop to it.
B. Hypnosis may change behavior and mood, but not to the point of raising pulse PLUS normotensive (partial response to endogenous adrenaline:unsure:? Or is the body compensating for some other cause for loss of BP? Or is the pt just transiently angry that he was stabbed in the arm?).
C. Does "semi-combative" mean resistive (which can be a basic irritant response) or want to fight? A difference clinically as to level of consciousness.
My quarter in the pool says most likely alcohol toxicity or psychoactive drugs, maybe baseline mental illness to boot. Calm everyone down, but get to medical facility as he will need pre-arrest screening including tox screen, blood alcohol.
PS: Another quarter: temp, PE and CBC to r/o sepsis.
I like to tell students taking a history and performing a physical is not like solving a mystery.
It is an interrogation and the desired outcome is confession.
"We spiked his drink" is also not something roomies will admit to.
mycrofft
Still crazy but elsewhere
- 11,322
- 48
- 48
MSDeltaFlt
RRT/NRP
- 1,422
- 35
- 48
This dude appears to be on a "bad trip", but not suppressed by narcotics. Respirations are good, so is BP, BGL, and SpO2. Plus you said pupils were PEARL, not pinpoint.
And suddenly you said he went "unresponsive on your cot" to explain the Narcan. When did his GCS drop? What were his VS when they dropped?